Opening a New Level II Trauma Center Near an Established Level I Trauma Center: Is This Good for Trauma Care?

Martin, Cody L.; Aldridge, Petra; Harris, Anthony M.; Perkins, Christopher H.

doi:10.1097/bot.0000000000000640

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Few studies have examined the consequences of changes in trauma center distribution over time from a population standpoint, instead focusing on regional or other local changes. [16][17][18][19] We sought to describe the distribution in trauma centers in the United States, characterize the trends in the growth versus removal of centers between 2014 and 2017, and identify any relationships in such trends to injury-related mortality (IRM). We hypothesized that having more trauma centers within a state would be associated with lower IRM.…”

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confidence: 99%

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Is more better? Do statewide increases in trauma centers reduce injury-related mortality?

Truong¹,

Ho²,

Tseng³

et al. 2021

J Trauma Acute Care Surg

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Trauma centers are inconsistently distributed throughout the United States. It is unclear if new trauma centers improve care and decrease mortality. We tested the hypothesis that increases in trauma centers are associated with decreases in injury-related mortality (IRM) at the state level. METHODS:We used data from the American Trauma Society to geolocate every state-designated or American College of Surgeons-verified trauma center in all 50 states and the District of Columbia from 2014 to 2018. These data were merged with publicly available IRM data from the Centers for Disease Control and Prevention. We used geographic information systems methods to map and study the relationships between trauma center locations and state-level IRM over time. Regression analysis, accounting for state-level fixed effects, was used to calculate the effect of total statewide number of trauma center on IRM and year-to-year changes in statewide trauma center with the IRM (shown as deaths per additional trauma center per 100,000 population, p value). RESULTS:Nationwide between 2014 and 2018, the number of trauma center increased from 2,039 to 2,153. Injury-related mortality also increased over time. There was notable interstate variation, from 1 to 284 trauma centers. Four patterns in statewide trauma center changes emerged: static ( 12), increased (29), decreased (5), or variable (4). Of states with trauma center increases, 26 (90%) had increased IRM between 2014 and 2017, while the remaining 3 saw a decline. Regression analysis demonstrated that having more trauma centers in a state was associated with a significantly higher IRM rate (0.38, p = 0.03); adding new trauma centers was not associated with changes in IRM (0.02, p = 0.8). CONCLUSION:Having more trauma centers and increasing the number of trauma center within a state are not associated with decreases in state-level IRM. In this case, more is not better. However, more work is needed to identify the optimal number and location of trauma centers to improve IRM.

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confidence: 99%

“…Despite this, new trauma centers continue to open without clear criteria or need. Few studies have examined the consequences of changes in trauma center distribution over time from a population standpoint, instead focusing on regional or other local changes 16–19 …”

mentioning

confidence: 99%

Is more better? Do statewide increases in trauma centers reduce injury-related mortality?

Truong¹,

Ho²,

Tseng³

et al. 2021

J Trauma Acute Care Surg

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“…2 Examples of before-and-after studies Before-and-after studies allow researchers to answer questions such as: Does the opening of a new trauma centre reduce admissions in surrounding hospitals? 3 Do sugar taxes reduce the consumption of sweetened beverages? 4 and Does the introduction of compulsory helmet legislation for cyclists reduce the rate of head injury?…”

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confidence: 99%

The dangers of ignoring underlying trends in before-and-after studies – A cautionary tale using hip fracture mortality data

Cheik-Hussein

Harris

Lewin

2020

J Orthop Surg (Hong Kong)

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Background: Before-and-after studies are a valuable study design in situations where randomization is not feasible. These studies measure an outcome both before and after an intervention and compare the outcome rates in both time periods to determine the effectiveness of the intervention. Before-and-after studies do not involve a contemporaneous control group and must, therefore, take into account any underlying secular trends to separate the effect of the intervention from any pre-existing trend. Methods: To illustrate the importance of accounting for underlying trends, we performed a before-and-after study assessing 30-day mortality in hip fracture patients without any actual intervention, and instead designated an arbitrarily chosen time point as our ‘intervention’. We then analysed the data first disregarding and then incorporating the pre-existing underlying trend. We did this to show that even intervention of nothing may be spuriously interpreted to have an effect if the before-and-after study design is incorrectly analysed. Our study involved a secondary analysis of routinely collected data on 30-day mortality following hip fracture in our institution. Results: We found a secular trend in our data showing improving 30-day mortality in hip fracture patients in our institution. We then demonstrated that disregarding this underlying trend showed that our intervention of nothing ‘resulted’ in a significant 54% decrease in mortality, from 6.7% in the ‘before’ period to 3.1% in the ‘after’ period ( p < 0.0008). Though the 30-day mortality rate decreased during the ‘after’ period, the decrease was not significantly different from the underlying trend in the ‘before’ period, projected onto the ‘after’ period. When we accounted for the underlying trend in our analysis, the impact of the intervention (nothing) on 30-day mortality was no longer apparent (incidence rate ratio 0.75, 95% confidence interval 0.32–1.78; p = 0.5). Conclusion: Our study highlights the importance of appropriate measurement and consideration of underlying trends when analysing data from before-and-after studies and illustrates what can happen should researchers neglect this important step.

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Invited Commentary: Trauma Center Growth in the United States—A Plea for Planning and Oversight

Jones

Schmidt

2016

Journal of Orthopaedic Trauma

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Opening a New Level II Trauma Center Near an Established Level I Trauma Center: Is This Good for Trauma Care?

Abstract: A significant decrease in patient volume was seen at the AL1TC with the initiation of the PL2TC in close proximity. Orthopaedic patient volume did not recuperate after the removal of the PL2TC status.

Cited by 3 publications

References 18 publications

Is more better? Do statewide increases in trauma centers reduce injury-related mortality?

Is more better? Do statewide increases in trauma centers reduce injury-related mortality?

The dangers of ignoring underlying trends in before-and-after studies – A cautionary tale using hip fracture mortality data

Invited Commentary: Trauma Center Growth in the United States—A Plea for Planning and Oversight

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